Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Nursery School Form

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S T A T E O F M A I N E
M A I N E R E V E N U E S E R V I C E S
ADMINISTRATIVE & FINANCIAL
2 4
S T A T E H O U S E S T A T I O N
SERVICE
,
A U G U S T A
M A I N E
REBECCA M. WYKE
0 4 3 3 3 - 0 0 24
COMMISSIONER
John Elias Baldacci
JEROME D. GERARD
GOVERNOR
ACTONG EXECTUTIVE DIRECTOR
APPLICATION FOR SALE/USE TAX EXEMPTION CERTIFICATE
FOR AN INCORPORATED NONPROFIT NURSERY SCHOOL
Name of Corporation
_______________________________________________________
Name of Nursery School
_______________________________________________________
Physical Location
_______________________________________________________
Mailing Address
_______________________________________________________
_______________________________________________________
The statute reads, "licensed, incorporated, nonprofit nursery school".
Is the nursery school incorporated? Yes ___ No ___
Send a copy of the articles of incorporation
Is the nursery school licensed by the Department of Behavioral and Developmental Services?
Yes___ No ___
Send a copy of the nursery school license received by the Department of Behavioral and
Developmental Services
Has the nursery school received 501(c) nonprofit status from the IRS? Yes ___ No ___
Send a copy of the IRS determination letter indicating 501(c) nonprofit status
IN ORDER TO PROCESS THE APPLICATION THE FOLLOWING MUST BE INCLUDED
1. Copy of the Articles of Incorporation, as well as a copy of the Constitution and/or By-law
2. Copy of the nursery school license from the Department of Behavioral and Developmental Services
3. Copy of the IRS determination letter indication 501(c) nonprofit status
I hereby certify that ______________________________________________________ is an incorporated
nonprofit nursery school licensed by the Department of Behavioral and Developmental Services. I therefore
request that a sales/use tax exemption certificate be issued to the above organization pursuant to Title 36 MRSA
1760 (43).
Date:: _________________________
Signature: ___________________________________________
Tel:___________________________
Print Name: __________________________________________
Fed ID# _______________________
Title: _______________________________________________
Fed ID ________________________
Date Facility Opened: __________________________________
ST-R-13A
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E A R I N G
M P A I R E D
H O N E
E-mail:
sales.tax@state.me.us

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